Provider Demographics
NPI:1609066109
Name:HALAT, SHAMS KHALIL (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMS
Middle Name:KHALIL
Last Name:HALAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5339 ODONOVAN DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4388
Mailing Address - Country:US
Mailing Address - Phone:225-766-4999
Mailing Address - Fax:225-767-4702
Practice Address - Street 1:5339 ODONOVAN DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4388
Practice Address - Country:US
Practice Address - Phone:225-766-4999
Practice Address - Fax:225-767-4702
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203575207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02303311Medicaid
LA1070033Medicaid
LA4P8187061Medicare PIN
MS02303311Medicaid